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Time to fully account for cost in monitoring financial protection and universal health coverage in low- and middle-income settings. 有时间充分考虑在低收入和中等收入环境中监测财务保护和全民健康覆盖的成本。
IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-23 DOI: 10.1093/heapol/czaf085
Peter Binyaruka, Josephine Borghi

Financial protection is a core pillar of universal health coverage (UHC), yet current monitoring approaches in low- and middle-income countries (LMICs) largely focus on direct medical costs, neglecting direct transport costs and indirect time costs lost when seeking care. This commentary highlights the importance of fully accounting for these often-excluded costs, which disproportionately affect poorer and rural populations and can significantly hinder access to essential health services and lead to foregone care. We outline five priority areas for action, including improved measurement of transport and time costs through household surveys, methodological advancements in valuing time, increased investment in primary health care to reduce physical access barriers, adaptation of financing schemes and social protection programs to cover non-medical costs, and a multisectoral approach to address structural determinants. Fully integrating these dimensions into financial protection metrics and policies is critical for ensuring more equitable progress toward UHC in LMICs.

财务保护是全民健康覆盖的核心支柱,但低收入和中等收入国家目前的监测方法主要侧重于直接医疗费用,而忽视了直接运输成本和就医时损失的间接时间成本。本评论强调充分考虑这些往往被排除在外的费用的重要性,这些费用对较贫困人口和农村人口的影响尤为严重,可能严重阻碍获得基本卫生服务并导致放弃护理。我们概述了五个优先行动领域,包括通过家庭调查改进运输和时间成本的衡量,在评估时间方面取得方法上的进步,增加对初级卫生保健的投资以减少实际准入障碍,调整融资计划和社会保护方案以覆盖非医疗成本,以及采取多部门方法解决结构性决定因素。将这些方面充分纳入财务保护指标和政策,对于确保中低收入国家在实现全民健康覆盖方面取得更公平的进展至关重要。
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引用次数: 0
Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy. 评估埃塞俄比亚东部产前保健的成本:对改善免费产妇服务政策的影响。
IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-23 DOI: 10.1093/heapol/czaf072
Tadesse Tolossa, Lisa Gold, Eric H Y Lau, Merga Dheresa, Julie Abimanyi-Ochom

Most sub-Saharan Africa (SSA) countries are implementing free maternity services starting from the first antenatal care (ANC) visit to postnatal care. However, out of pocket (OOP) health expenditures significantly affect the utilization of maternal services in SSA. Limited evidence exists on the costs incurred for ANC health service utilization in this region. This study aimed to assess the costs of ANC service utilization among adolescent and adult women in Eastern Ethiopia. Data were collected from pregnant women participating in the Kersa Health and Demographic Surveillance Site (KHDSS). The study prospectively followed 394 pregnant women across two rounds, collecting both direct medical and indirect costs of ANC service utilization. Direct medical and non-medical costs were summed up to give OOP health expenditures. Catastrophic health expenditure (CHE) and intensity were assessed using the budget share approach at different thresholds. All costs were converted to 2023/2024 USD and compared between adolescent and adult women. A total of 390 women were included in the final analysis. The total amount of OOP payment due to ANC service utilization was 35.7 USD among adolescents compared to 28.5 USD in adults. Adolescents spent 32.6 USD on direct medical costs compared to 24.9 USD for adult women, and 19.3 USD on direct non-medical costs compared to 19.8 USD in adult women. There was a significant difference in the proportion of women who incurred OOP payments, 85.7% of adolescents versus 66.7% of adults (P-value < .001). CHE incidence among adolescents was 46.8% and 15.6% compared to 28.7% and 9.3% among adult women at 5% and 15% threshold, respectively. Overall, adolescent women faced higher financial hardship than adult women. This highlights the need to expand financial protection beyond direct medical costs and to develop targeted financial protection mechanisms specifically for adolescents in resource-limited settings. Furthermore, strengthening the implementation and ensuring the sustainability of the Free Maternal Services policy could help reduce disparities in service utilization between adolescent and adult women.

大多数撒哈拉以南非洲国家正在实施从第一次产前护理到产后护理的免费产妇服务。然而,自付保健支出严重影响了SSA孕产妇服务的利用。关于本区域非洲裔国民保健服务使用费用的证据有限。这项研究的目的是评估埃塞俄比亚东部青少年和成年妇女使用ANC服务的成本。数据收集自参加Kersa健康和人口监测站(KHDSS)的孕妇。该研究对394名孕妇进行了两轮前瞻性随访,收集了ANC服务使用的直接医疗和间接成本。将直接医疗费用和非医疗费用相加,得出面向对象的卫生支出。采用不同阈值的预算份额法评估了灾难性卫生支出(CHE)和强度。所有费用转换为2023/2024美元,并在青少年和成年女性之间进行比较。总共有390名女性参与了最后的分析。青少年因使用ANC服务而产生的OOP支付总额为35.7美元,而成人为28.5美元。青少年的直接医疗费用为32.6美元,而成年女性为24.9美元;青少年的直接非医疗费用为19.3美元,而成年女性为19.8美元。发生OOP付款的女性比例有显著差异,青少年为85.7%,成人为66.7% (p值)
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引用次数: 0
Correction to: Can medical consortiums bridge the gap in health inequity in China? A propensity score matching analysis. 更正:医疗联盟能弥合中国医疗不平等的鸿沟吗?倾向评分匹配分析。
IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-23 DOI: 10.1093/heapol/czaf095
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引用次数: 0
Self-reported job histories: potential value of the method in health policy and systems research. 自我报告的工作经历:该方法在卫生政策和系统研究中的潜在价值。
IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-21 DOI: 10.1093/heapol/czaf076
Bhaskar Purohit, Felix Orole, Peter S Hill

In the absence of documented health workforce deployment policies and limited access to key job history data, existing health systems research methods are inadequate for examining policy implementation. The analysis of self-reported job histories offers a valuable research method for overcoming these limitations; however, its application and usefulness remain largely unexamined in health system and policy research, particularly in the context of health workforce and policy implementation. In this paper, we reflect on our experiences of using self-reported job histories to investigate the experiences of public sector doctors with deployment systems related to recruitment, initial posting, and transfers. We interviewed 33 public sector doctors from two Indian states to gain insight into their experiences with policies and systems related to deployment. The initial interview process revealed a pattern in which the doctors developed a work-life chronology to organize their responses. This was formalized in subsequent interviews, creating structured chronological job histories. Job histories serve as a useful and flexible research method for understanding the complexities of how health workforce deployment systems operate and are experienced by health workers. Commentary by doctors regarding these job histories revealed negative perceptions of transfer practice, disruptions in their career trajectories, and gaps in policy implementation. The recollection process of forming job histories is organic and fluid, rich in qualitative data, and its construction involves making sense of diverse work-related stories of health workers. Job histories offer flexibility for collecting data in a more structured manner through a simple set of quantitative questions. Despite their usefulness, constraints such as the inability to triangulate and recall bias exist. Beyond research, job history analysis has practical implications; it is useful for policy implementers and researchers through a more nuanced analysis of challenges related to effective workforce management systems, thereby improving workforce planning, policies, and systems.

由于缺乏记录在案的卫生人力部署政策和获取关键工作历史数据的机会有限,现有的卫生系统研究方法不足以审查政策实施情况。对自我报告的工作经历的分析为克服这些限制提供了一种有价值的研究方法;然而,在卫生系统和政策研究中,特别是在卫生人力和政策实施方面,其应用和有用性在很大程度上仍未经审查。在本文中,我们反思了我们使用自我报告的工作经历来调查公共部门医生与招聘,初始职位和转移相关的部署系统的经验。我们采访了来自印度两个邦的33名公共部门医生,以深入了解他们在与部署相关的政策和系统方面的经验。最初的采访过程揭示了一种模式,医生们制定了一个工作-生活年表来组织他们的回答。这在随后的面试中被正式化,形成了结构化的按时间顺序排列的工作经历。工作经历是一种有用和灵活的研究方法,可用于了解卫生人力部署系统如何运作和卫生工作者如何体验的复杂性。医生对这些工作经历的评论揭示了对迁移实践的负面看法,他们的职业轨迹中断,以及政策执行方面的差距。形成工作经历的回忆过程是有机和流动的,具有丰富的定性数据,其构建涉及对卫生工作者各种工作相关故事的理解。通过一组简单的定量问题,工作历史为以更结构化的方式收集数据提供了灵活性。尽管它们很有用,但存在诸如无法三角测量和回忆偏差等限制。除了研究,工作经历分析也有实际意义;通过对与有效的劳动力管理系统相关的挑战进行更细致的分析,从而改进劳动力规划、政策和系统,对政策执行者和研究人员很有用。
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引用次数: 0
Justice at the interface: advancing community and health system resilience through intersectionality theory. 界面上的正义:通过交叉性理论提高社区和卫生系统的复原力。
IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-19 DOI: 10.1093/heapol/czag005
Jen Roux, Neelke Doorn, Saba Hinrichs-Krapels, Samantha Copeland

Current approaches to health system resilience tend to prioritize system-level outcomes (e.g. functionality) while overlooking key underlying social processes, contexts, and power-laden interactions through which resilience is produced. When community resilience is subsumed under health system resilience, without attending to distinct contextual factors, it can lead to fragmented approaches or maladaptive outcomes that misalign with the resilience of communities. Therefore, resilience approaches need to include additional methods that incorporate analyses of power structures and context. We propose intersectionality theory as a methodological lens to investigate the underlying social processes and power dynamics that shape community resilience and health system resilience interactions. An intersectionality approach prompts researchers to distinguish how resilience capacity is derived through the involvement of community actors, their unique intersecting social identities and their lived experiences. Including an intersectional lens in resilience approaches provides researchers with the tools to identify points of practical constraints that arise at the intersection of communities and health systems, with particular attention on the burdens that are placed on community actors.

目前卫生系统复原力的方法往往优先考虑系统级结果(例如功能),而忽略了产生复原力的关键潜在社会过程、背景和充满权力的相互作用。如果将社区恢复力纳入卫生系统恢复力,而不考虑不同的背景因素,就可能导致方法分散或适应不良的结果,与社区的恢复力不一致。因此,弹性方法需要包括其他方法,包括对权力结构和背景的分析。我们提出交叉性理论作为方法论的镜头来调查潜在的社会过程和权力动态,塑造社区弹性和卫生系统弹性的相互作用。交叉性方法促使研究人员区分弹性能力是如何通过社区行动者的参与、他们独特的交叉社会身份和他们的生活经历而产生的。在复原力方法中纳入交叉视角为研究人员提供了工具,以确定在社区和卫生系统交叉点出现的实际限制点,并特别关注社区行为者所承受的负担。
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引用次数: 0
Pathways of change for essential newborn care practices and health care seeking: a process evaluation of Mamás del Río, a community-based, maternal and neonatal health intervention in the Peruvian Amazon. 基本新生儿护理做法和寻求保健的变革途径:对秘鲁亚马逊地区基于社区的孕产妇和新生儿保健干预措施Mamás del Río的进程评价。
IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-17 DOI: 10.1093/heapol/czag004
Stefan Reinders, Magaly M Blas, Angela Alva, Luis Huicho, Carine Ronsmans, Isabelle L Lange

In rural Indigenous communities in the Peruvian Amazon, access to quality care is difficult, home births are frequent, and neonatal mortality remains high. Peru has a large cadre of Community health workers (CHW), yet their potential is not harnessed. A recent outcome evaluation of a community-based intervention showed improvements in essential newborn care (ENC) for home births and small increases in facility births. To explain these findings, elucidate the pathways of change, and derive policy recommendations, we conducted a mixed-methods process evaluation. Implementation strength, mechanisms of change, and influence of contextual factors were assessed using data collected from women, CHW, traditional birth attendants (TBA), supervisors, and community members. We calculated programme coverage and intervention exposure and explored experiences, perceptions, and birth stories through interviews, focus group discussions, and participant observation using content analysis. Triangulated findings were narratively synthesized and contrasted to hypothesized intervention mechanisms. The programme achieved high coverage of well-trained CHW and TBA supported by intensive supervision. Multiple pathways of change were identified: Trained TBA as main providers of home-based birth care implementing ENC; CHW home visits sensitizing women through educational videos and provision of delivery kits, albeit with less reach and counselling than expected; and supervisor-led, women-only educational meetings. Some CHW proactively facilitated access to facility care, while promotion alone to increase demand appeared insufficient. Pathways of change identified support a causal link between the intervention and observed behaviour changes in the outcome evaluation. Our findings demonstrate the potential of community-based approaches involving CHW and TBA which should be given greater importance in national health policy. To improve impact and sustainability of the Peruvian CHW programme, we provide several context-specific recommendations.

在秘鲁亚马逊地区的农村土著社区,很难获得高质量的护理,在家分娩很常见,新生儿死亡率仍然很高。秘鲁有一支庞大的社区卫生工作者骨干队伍,但他们的潜力没有得到利用。最近对社区干预的结果评估显示,在家分娩的新生儿基本护理(ENC)有所改善,在医院分娩的新生儿基本护理(ENC)略有增加。为了解释这些发现,阐明变化的途径,并得出政策建议,我们进行了混合方法的过程评估。使用从妇女、CHW、传统助产士(TBA)、主管和社区成员收集的数据,评估实施力度、变化机制和环境因素的影响。我们计算了项目覆盖率和干预曝光率,并通过访谈、焦点小组讨论和使用内容分析的参与者观察来探索经验、观念和出生故事。对三角测量结果进行叙述综合,并与假设的干预机制进行对比。该计划在强化监督的支持下,使训练有素的卫生保健员和TBA的覆盖率很高。确定了多种改变途径:训练有素的TBA成为实施ENC的家庭分娩护理的主要提供者;妇女福利委员会家访,通过教育录像和提供分娩工具包,提高妇女的认识,尽管接触范围和咨询少于预期;以及由主管领导的女性专用教育会议。一些保健院积极促进设施护理,而仅靠宣传来增加需求似乎是不够的。在结果评估中,已确定的变化途径支持干预与观察到的行为变化之间的因果关系。我们的研究结果表明,以社区为基础的方法,包括CHW和TBA,应该在国家卫生政策中给予更大的重视。为了提高秘鲁CHW项目的影响力和可持续性,我们提供了一些具体情况的建议。
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引用次数: 0
Primary health care networks and impacts in LMICs: A systematic review. 中低收入国家的初级卫生保健网络及其影响:一项系统综述。
IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-16 DOI: 10.1093/heapol/czag003
Dominic Dormenyo Gadeka, Genevieve Cecilia Aryeetey, Helen Bour, Henry Okudzeto, Patrick Addo, Noemia Teixeira de Siqueira Filha, Bassey Ebenso, Helen Elsey, Irene A Agyepong

Primary healthcare provider networks (PHCPNs) are increasingly recognized as promising strategies to effectively strengthen health systems in low- and middle-income countries (LMICs). However, there is limited information on the influence PHCPNs may have on the process and clinical outcomes of health services. This study sought to answer the questions: what is the extent, range and nature of research on PHCPNs in LMICs, what are the types of PHCPNs described, and what are the processes e.g. access to care, coverage of health services, quality of care and services, safety of care and the clinical care outcomes of PHCPNs reported in the published literature? We report on a systematic mixed-methods review on PHCPNs as a strategy to strengthen health systems in LMICs following the PRISMA guidelines. The quality of the included studies was assessed using the ROBINS-I and Mixed Methods Appraisal tools, while a narrative synthesis was employed to describe the results. Fifteen primary studies were found eligible for the review. From the included papers, eight types of PHCPNs were identified across various contexts and countries. We found that the PHCPNs primarily focus on maternal, newborn, and child health outcomes. The study reveals that: (1) PHCPNs contribute to improvements in the process outcomes of health services by enhancing access to care, coverage of health services, quality of care and services, and safety of care, and (2) they support improvements in clinical outcomes by helping to reduce maternal, neonatal, and perinatal mortalities and stillbirths. This body of literature we reviewed suggests that PHCPNs make a difference in the process and clinical outcomes of health services in LMICs. This review serves as both a mapping and clarification exercise to promote the adoption of PHCPNs and as a foundation for further research, especially in areas of health services beyond maternal, newborn, and child health.

初级卫生保健提供者网络(phcpn)越来越被认为是有效加强低收入和中等收入国家卫生系统的有前途的战略。然而,关于初级国民保健网络对保健服务的过程和临床结果可能产生的影响的信息有限。本研究试图回答以下问题:低收入和中等收入国家phcpn研究的程度、范围和性质是什么,所描述的phcpn类型是什么,以及已发表文献中报道的phcpn的过程是什么,例如获得护理、卫生服务的覆盖范围、护理和服务的质量、护理的安全性和临床护理结果?我们报告了一项系统的混合方法综述,将PHCPNs作为一种战略,根据PRISMA指南加强中低收入国家的卫生系统。采用ROBINS-I和混合方法评估工具对纳入研究的质量进行评估,同时采用叙述性综合方法描述结果。有15项初步研究符合评价标准。从纳入的论文中,确定了不同背景和国家的八种phcpn类型。我们发现phcpn主要关注孕产妇、新生儿和儿童的健康结果。该研究表明:(1)phcpn通过增加获得保健的机会、保健服务的覆盖面、保健和服务的质量以及保健的安全性,有助于改善保健服务的过程结果;(2)它们通过帮助减少孕产妇、新生儿和围产期死亡率和死胎,支持改善临床结果。我们回顾的这部分文献表明,phcpn对中低收入国家卫生服务的过程和临床结果产生了影响。这一审查既是一项绘图工作,也是一项澄清工作,以促进采用初级保健和初级保健网络,并作为进一步研究的基础,特别是在孕产妇、新生儿和儿童健康以外的卫生服务领域。
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引用次数: 0
Health systems resilience and private-for-profit sector engagement: lessons from the second COVID-19 wave in Uttar Pradesh, India. 卫生系统复原力和私营-营利部门参与:从印度北方邦第二次COVID-19浪潮中吸取的教训。
IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-13 DOI: 10.1093/heapol/czag001
Ankita Meghani, Shreya Hariyani, Prabhjeet Singh, Sara Bennett

India's second wave of the COVID-19 pandemic in April-June 2021 involved an explosion of case numbers, with devastating consequences for the country's already strained health systems. This case study examines the private health market response to the pandemic in Uttar Pradesh, India's most populous state. We analyzed 203 news articles to understand both the experiences of private providers and patients in response to government policies being implemented in the state. This analysis informed our interviews with 20 state-level officials, district-level key informants, and formal and informal private-for-profit providers across 3 districts. We found that private sector hospitals were rapidly engaged to manage a surge in new infections and severe cases, but private bed capacity quickly filled, causing patients to be turned away. Informal private providers played a vital role in rural areas, serving as round-the-clock care sources. However, the news media reported inadequate medical care from such providers leading to COVID-19-related deaths. Access to reliable information on COVID-19 was challenging and social media became a platform for citizens and providers to share information about available resources, treatment, and COVID-19 management. However, misinformation also spread. While the government attempted to counter misinformation and regulate private hospitals, challenges persisted in providing and accessing accurate information. Oxygen and drug supply challenges also emerged, with private hospitals requiring patients to arrange oxygen due to scarcity. To address this and rising costs of care, the government issued price caps, monitored overcharging, and regulated drug and oxygen distribution. Government schemes also attempted to provide insurance for both public and private health workers, however, awareness and implementation of such schemes were inadequate. Policymakers should develop mechanisms to engage, or where relevant, integrate all private-for profit providers onto a common platform, strengthen referral linkages amongst them, and support communities of practice to increase awareness of government health policies and improve the implementation of government schemes. All together, these measures would help facilitate equitable access to care and help manage current health needs and future health emergencies.

2021年4月至6月,印度爆发了第二波COVID-19大流行,病例数量激增,给该国本已紧张的卫生系统带来了毁灭性后果。本案例研究考察了印度人口最多的北方邦私营卫生市场对大流行的反应。我们分析了203篇新闻文章,以了解私人提供者和患者对该州正在实施的政府政策的反应。这一分析为我们采访了3个地区的20名州级官员、区级关键举报人以及正式和非正式私营营利性提供者提供了信息。我们发现,私营医院迅速投入到处理新感染病例和重症病例激增的工作中,但私营医院的床位很快就被填满了,导致病人被拒之门外。非正式的私人提供者在农村地区发挥了至关重要的作用,作为全天候的护理来源。然而,新闻媒体报道称,这些提供者提供的医疗服务不足,导致与covid -19相关的死亡。获取关于COVID-19的可靠信息具有挑战性,社交媒体成为公民和提供者分享有关可用资源、治疗和COVID-19管理信息的平台。然而,错误信息也在传播。虽然政府试图打击虚假信息并规范私立医院,但在提供和获取准确信息方面仍然存在挑战。氧气和药品供应方面的挑战也出现了,由于短缺,私立医院要求病人安排氧气。为了解决这一问题和不断上涨的医疗成本,政府制定了价格上限,监控了过度收费,并监管了药品和氧气的分配。政府计划也试图为公共和私营保健工作人员提供保险,但是,对这类计划的认识和执行不足。决策者应建立机制,使所有私营营利提供者参与,或在相关情况下将其纳入一个共同平台,加强它们之间的转诊联系,并支持实践社区提高对政府卫生政策的认识,改进政府计划的执行。所有这些措施将有助于促进公平获得保健,并有助于管理当前的卫生需求和未来的突发卫生事件。
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引用次数: 0
Identifying Community Pharmacists Preferences for Attributes of Public Health Interventions in Kenya: A Discrete Choice Experiment. 识别社区药剂师对肯尼亚公共卫生干预属性的偏好:一个离散选择实验。
IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-12 DOI: 10.1093/heapol/czag002
Audrey Mumbi, Gilbert Abotisem Abiiro, Jacob Kazungu, Jacinta Nzinga, Edwine Barasa

Community pharmacies are increasingly recognised as access points for public health interventions (PHIs) such as vaccination, family planning services and disease screening. In Kenya, evidence suggests feasibility of pharmacy delivered PHIs, however, the uptake remains inconsistent. This is partly attributed to poor program design without taking pharmacy providers preferences into consideration. We employed a discrete choice experiment (DCE) to investigate community pharmacists preferences for attributes of PHIs delivered in community pharmacies in Kenya. We constructed a Bayesian efficient design and conducted a DCE survey among 663 community pharmacy providers in Makueni, Nairobi and Kisumu counties in Kenya from January 2025 to March 2025. Panel multinomial mixed logit, generalised multinomial logit and latent class models were used in the analysis. We also estimated willingness to pay (WTP) and willingness to accept (WTA) estimates using cost and profit margins as the monetary estimates respectively. We found that community pharmacists were willing to offer PHIs with a low preference for opting out (β=-3.5723, P<0.01). Preferences for PHIs significantly increased with higher profit margins (β=0.028, P<0.01) and decreased with higher cost of equipment (β= -0.00023, P<0.01). There were higher preferences for PHIs that require moderate training (β=0.266, P<0.01) and extensive training (β=0.141, P<0.05) compared to no additional training; and lower preferences for PHIs with complex interventions compared to simple interventions (β=-0.323, P<0.01). The WTP estimates showed that providers were willing to pay Khs. 11,738 (USD 90) for moderate training and Kshs. 7,327 (USD 56) for extensive training. Moreover, the WTA estimates showed that providers were willing to accept a 10.9% increase in profit margin in order to deliver complex interventions. In addition to this, a three-class latent class model revealed preference heterogeneity among the respondents. These findings can be used to inform the design of PHIs to enhance uptake and acceptability among providers.

社区药房越来越被认为是公共卫生干预措施(PHIs)的接入点,例如疫苗接种、计划生育服务和疾病筛查。在肯尼亚,有证据表明药房提供公共卫生信息的可行性,然而,采用情况仍然不一致。这部分是由于糟糕的程序设计没有考虑到药房提供者的偏好。我们采用离散选择实验(DCE)来调查社区药剂师对肯尼亚社区药房提供的公共卫生信息属性的偏好。我们构建了贝叶斯有效设计,并于2025年1月至2025年3月对肯尼亚Makueni、Nairobi和Kisumu县的663家社区药房提供者进行了DCE调查。分析中使用了面板多项混合logit、广义多项logit和潜在类模型。我们还分别使用成本和利润率作为货币估计来估计支付意愿(WTP)和接受意愿(WTA)估计。我们发现,社区药剂师愿意提供公共卫生信息,选择退出的偏好较低(β=-3.5723, P
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引用次数: 0
Untangling the complex web of alcohol policy needs and potential solutions in Brazil: evidence from civil society and political stakeholders. 解开巴西酒精政策需求和潜在解决方案的复杂网络:来自民间社会和政治利益攸关方的证据。
IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-18 DOI: 10.1093/heapol/czaf104
Inaê Valério, Isabelle Uny, Alejandra Burela, Marina Piazza, Mark Petticrew, Niamh Fitzgerald, Zila M Sanchez

Implementing evidence-based alcohol policies can reduce the negative impact of alcohol consumption on public health. However, Brazil has permissive alcohol policies and weakly adheres to World Health Organization's recommendations as the 'best buys'. To explore stakeholders' perceptions of alcohol policy needs and barriers in Brazil, we conducted semi-structured interviews with 31 stakeholders, including 15 from civil society and 16 policymakers. Civil society participants included non-governmental organization leaders addressing alcohol-related issues, while policymakers comprised civil servants and politicians experienced in alcohol-related harms. Interviews were transcribed verbatim and thematically analyzed using a deductive approach guided by research questions and an inductive approach to identify emergent themes. Most participants supported World Health Organization-recommended 'best buy' policies regulating alcohol's marketing. However, agreement on price and availability control was not unanimous. All participants acknowledged significant political barriers to adopting these policies, including intentional delays in parliamentary voting, industry lobbying, and arguments about infringing on rights such as freedom. Facing obstacles to advancing population-level policies, stakeholders often shifted their focus to individual-level interventions, such as education and treatment. While these were recognized as less effective, educational efforts were highlighted for raising public awareness of alcohol's harms and changing normative beliefs. Participants noted the lack of a formal coalition to reduce alcohol-related harm, despite its perceived necessity. Overall, stakeholders supported population-level alcohol policies but were pessimistic about their implementation due to political barriers. Many, particularly from civil society, emphasized small-scale, targeted interventions as a more feasible alternative to address alcohol-related harm in Brazil.

实施循证饮酒政策可以减少酒精消费对公共卫生的负面影响。然而,巴西的酒精政策是宽松的,并且很少遵守世界卫生组织的建议,认为这是“最划算的”。为了探讨利益相关者对巴西酒精政策需求和障碍的看法,我们对31名利益相关者进行了半结构化访谈,其中15名来自民间社会,16名来自政策制定者。民间社会的参与者包括处理与酒精有关问题的非政府组织领导人,而决策者则包括经历过与酒精有关危害的公务员和政治家。访谈被逐字记录下来,并使用由研究问题和归纳方法指导的演绎方法对主题进行分析,以确定紧急主题。大多数与会者支持世界卫生组织(World Health organization)推荐的监管酒类营销的“最划算”政策。然而,在价格和供应控制方面的协议并不是一致的。所有与会者都承认,实施这些政策存在重大的政治障碍,包括故意拖延议会投票、行业游说以及有关侵犯自由等权利的争论。面对推进人口层面政策的障碍,利益攸关方往往将重点转向个人层面的干预措施,如教育和治疗。虽然这些措施被认为效果较差,但强调了教育工作,以提高公众对酒精危害的认识,并改变规范观念。与会者指出,尽管认为有必要成立一个正式的联盟来减少与酒精有关的危害,但却缺乏这个联盟。总体而言,利益攸关方支持人口层面的酒精政策,但由于政治障碍,对其实施持悲观态度。许多人,特别是民间社会的许多人强调,小规模、有针对性的干预是解决巴西与酒精有关的危害的更可行的替代办法。
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Health policy and planning
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